| Name: |
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| Phone No : |
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| Company Name : |
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| Address : |
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| Postcode : |
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| Email : |
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| Renewal Date : |
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| Target Premium (£) : |
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| Main trade : |
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| BUSINESS DETAILS |
| Nature of Business : |
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| Details of Products Manufactured : |
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| Number of Years Trading : |
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| COVER REQUIRED |
| General Contents : |
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| Buildings Sum Insured (£) : |
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| Is Subsidence Cover Required? : |
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| Glass & Signs (£) : |
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| Fixtures, Fittings, Plant & Machinery (£) : |
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| Stock (£) : |
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| Examples of Type of Stock : |
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| Non Ferrous Stock (£) : |
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| Computer& Electronic Office Equipment (£) : |
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| Optional Extensions : |
| Stock In Transit (£) : |
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| All Risks Cover for Laptops (£) : |
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| Money Cover (£) : |
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| Business Interruptions Cover (£) : |
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| Estimated Annual Turnover : |
| U.K. (£) : |
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| E.U. (£) : |
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| USA/Canada (£) : |
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| Details of Countries Exported to : |
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| PUBLIC/PRODUCTS LIABILITY : |
| Limit of Indemnity : |
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| EMPLOYERS LIABILITY : |
| Employers Liability is standard in the UK at £10 Million. |
| Clerical/Managerial Wage Roll (£) : |
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| No of Clerical/Managerial Employees : |
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| Manual Wage Roll (£) : |
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| No of Manual Employees : |
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| Details of Work Away From Premises : |
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| Additional Information : |
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| Details of Work Outside of U.K. : |
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| STATEMENT OF FACT |
1. The premises are of standard construction i.e. built with brick, stone or concrete walls and slate, tile, metal or asbestos roofs and in a good state of repair
2. You are the sole occupants and the premises are self-contained
3. Any flat roof area does not exceed 15% of total roof area
4. The premises are in an area free from flooding and subsidence
5. You have no adverse insurance, economic or personal history
6. You comply with the minimum levels of physical security i.e. all external entry/exit doors are fitted with 5 lever mortice deadlocks complying to BS3621 & all accessible windows are either barred, grilled or fitted with key operated window locks.
7. There are no other material facts that may affect an insurers willingness to offer you cover |
If you agree with the above statements please tick here : |
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If you do not agree with any of the above statements please tick here and give full details below : |
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| Comments : |
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| ADDITIONAL INFORMATION |
| Are the premises protected by a N.A.C.O.S.S. approved alarm? : |
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| Is Police Response Operational? : |
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| Are the premises protected by CCTV? : |
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| Please detail any other security factors : |
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| Details of ALL and ANY claims or losses in the last five years : |
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| Additional Information/Comments : |
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